The long-term objective of this project is to identify underlying causes of Black-White differences in the likelihood of receiving definitive (potentially curative) therapy for prostate cancer (CaP) and treatment decision-making distress and regret. This knowledge is needed to design and implement interventions that will reduce racial gaps in CaP mortality and treatment decision-making distress and regret. Increasing the likelihood that Black men will receive definitive therapy when it is clinically appropriate is a critically important public health challenge. Black men are more than twice as likely to die from CaP as White men, with much of this difference attributable to Black-White differences in the receipt of definitive treatment. Recent evidence indicates that Black men are more likely to experience treatment decision-making difficulty and post-treatment decision regret. Both may stem from a common set of determinants that result in the breakdown of the treatment decision-making process for some Black men. The central hypothesis of the proposed study is that racial dynamics in the health care system result in Black men being less likely to receive definitive treatment, and more likely to experience decision-making difficulty, distress, and treatment decision regret. To test the central hypothesis we will execute three Specific Aims: 1) Identify race-related variability in the factors that influence CaP treatment decision-making; 2) assess Black-White differences in CaP treatment decision-making distress, and identify determinants of these differences; and 3) assess Black-White differences in CaP post-treatment decision regret, and identify determinants of these differences. Over the course of three years, approximately 589 non-Hispanic Black (28% of sample) and 1517 non-Hispanic White men diagnosed with clinically localized CaP will be accrued in the study. They will be recruited from four major medical centers. After participants have decided how to treat their cancer, but before they have received treatment, participants will complete a self-administered mail-in paper-and-pencil survey that will inquire into their treatment choice and treatment decision-making process. At their 6-week, 1-year and 2-year post-treatment clinic visits they will also complete questionnaires inquiring into their quality of life and post-treatment decision regret. Little is known about factors that could lead to a breakdown in the CaP treatment decision-making process for Black men. The proposed study will be the first to test whether racial dynamics shown to be common in other health care domains (e.g., Black-White differences in the likelihood of having experienced racial discrimination in health care settings, physician distrust, and racial differences in patient involvement in treatment decision-making, and satisfaction with health care) contribute to Black-White differences in receipt of definitive therapy and treatment decision-making distress and regret. PUBLIC HEALTH RELEVANCE: Not only do Black men suffer higher mortality from prostate cancer than White men, they are less likely to receive curative therapy and they may be more likely to experience treatment decision-making distress and regret. The proposed research will test whether these differences emerge from a pattern of racial dynamics (e.g., past experiences of discrimination, low trust in physicians, and less involvement in treatment-decisions) that have been shown to be widespread among Blacks and to impair medical care. Identifying why Black men are disproportionately less likely to receive clinically appropriate prostate cancer care and experience more decision-making difficulty and regret will provide a necessary understanding for developing and implementing interventions that will ultimately reduce racial differences in prostate cancer mortality and prostate cancer- associated distress.